Florence Nightingale: Nursing Pioneer

Florence Nightingale

• Established the first nursing philosophy, known as Nightingale's Environmental Theory, which focuses on health maintenance and restoration through improving a patient's environment (ventilation, light, reduced noise, hygiene, and nutrition).
• Organized the first program for training nurses.
• Was the first practicing epidemiologist.
• Improved sanitation in battlefield hospitals.
• Her practices remain a basic part of nursing today.

Historical Influences

• Clara Barton was the founder of the American Red Cross.
• Dorthea Lynde Dix organized hospitals during the Civil War.
• Mary Ann Ball (Mother Bickerdyke) helped Dix during the Civil War.
• Harriet Tubman was part of the Underground Railroad Movement.
• Mary Mahoney was the first educated African American nurse.
• Isabel Hampton Robb was involved in the American Nurses Association (ANA) and the American Journal of Nursing.
• Lillian Wald opened the Henry Street Settlement.
• Mary Brewster also opened the Henry Street Settlement.

Twentieth Century

• There was a movement towards scientific, research-based practice and a defined body of knowledge.
• Nurses assumed expanded roles.
• In 1906, Mary Adelaide Nutting was instrumental in moving nursing education into universities.
• In the 1920s, nursing specialization began.
• In 1990, the ANA established the Center for Ethics and Human Rights.
• In 1994, the University of Washington Medical Center became the first Magnet-designated organization.

Twenty-First Century

• Nurses are revising nursing practice and school curricula to meet the ever-changing needs of society.
• This includes accommodating an aging population, cultural diversity, bioterrorism, emerging infections, and disaster management.

Contemporary Influences

• The importance of nurses' self-care is emphasized.
• Health care reform and costs are a concern.
• Demographic changes and medically underserved populations are also significant.

Trends in Nursing

• Evidence-based practice is essential.
• Quality and Safety Education for Nurses (QSEN) is a key aspect.
• The impact of emerging technologies, genomics, and public perception of nursing are also significant.
• The impact of nursing on politics and health policy is growing.

Quality and Safety Education for Nurses (QSEN)

• Patient-centered care recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care.
• Teamwork and collaboration involve functioning effectively within nursing and interprofessional teams.

(ANA) Standards of Professional Performance

• Ethics are essential.
• Advocacy and respectful and equitable practice are important.
• Communication, collaboration, and leadership are also key.
• Education, scholarly inquiry, and quality of practice are vital.
• Professional practice evaluation, resource stewardship, and environmental evaluation are also significant.

Professional Responsibilities and Roles

• Autonomy and accountability are essential.
• Nurses take on roles as caregivers, advocates, educators, communicators, managers, and researchers.

Career Development

• Nurses can pursue careers as clinicians, advanced practice registered nurses, nurse educators, nurse administrators, and nurse researchers.

American Nurses Association (ANA)

• Professional practice includes knowledge from social and behavioral sciences, biological and physiological sciences, and nursing theories.
• Nursing practice incorporates ethical and social values, professional autonomy, and a sense of commitment and community.

(ANA) Standards of Practice

• Also known as the "Nursing Process", a model for clinical decision making.
• Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values.

QSEN

• Quality improvement involves using data to monitor the outcomes of care processes and improvement methods.
• Safety involves minimizing risk of harm to patients and providers.
• Informatics involves using information and technology to communicate, manage knowledge, mitigate error, and support decision making.

Professional Registered Nurse Education

• Prelicensure education options include 2-year associate's degrees and 4-year bachelor's degrees.
• Graduate education options include master's degrees for advanced practice RNs and doctoral preparation.
• Continuing and in-service education are also essential.

Nursing Practice

• Nurse Practice Acts (NPAs) regulate scope of nursing practice and protect public health, safety, and welfare.
• Licensure and certification are required, with licensure involving the NCLEX-RN examination and certification requirements varying.

Health Care Delivery System

• Four significant challenges facing the nursing profession include:
  • The aging baby boomer generation
  • The shortage and uneven distribution of physicians
  • The rate of nurses' retirements
  • The uncertainty of health care reform

Levels of Health Care

• Traditional levels of health care include:
  • Preventative care
  • Primary care
  • Secondary care
  • Tertiary care
  • Restorative care
  • Continuing health care

Integrated Health Care Delivery

• Primary and preventive health care services aim to:
  • Improve health outcomes for entire populations
  • Require collaboration among health professionals, leaders, and community members
  • Reduce disease incidence through health promotion programs
  • Control risk factors for disease through preventive care

Secondary and Tertiary Care

• Services provided in secondary and tertiary care settings include:
  • Hospital care
  • Intensive care
  • Mental health facilities
  • Rural hospitals
  • Discharge planning

Restorative Care

• Restorative care services include:
  • Home care
  • Rehabilitation
  • Extended care facilities

Continuing Care

• Continuing care services include:
  • Nursing centers or facilities
  • Assisted living
  • Respite care
  • Adult day care centers
  • Palliative and hospice care